I put on my heavy canvas taekwondo uniform and fastened my belt around my waist. As I nervously paced the room, I mentally rehearsed my board breaks in my head: the set-up, the execution, the feeling of my heel smashing through 2 inches thick of pine, and the sheer elation afterwards.

And then it was my turn. I was called up to do my taekwondo grading, and suddenly all I had learnt over the past decade came into practice. As anticipated, there were a few hiccups along the way – my first round fight scored me a split lip after a rogue punch from my opponent, my already tender hamstring had started to cramp, and one of my board breaks took multiple attempts after I misjudged my aim. Nevertheless, I pushed on. Punch after punch, kick after kick, jump after jump. Until finally, we reached the end, and I felt like there was nothing left in the tank, I was exhausted. But I knew that I had done everything I could – I stayed calm in the chaos, I persevered through the physical pain, and I knew that even if I wasn’t awarded my belt in the end, I could honestly say I had tried my best. Fortunately for me on that day in my final year of medical school, I was successfully promoted to 2nd Dan black belt. I can say without a shred of doubt that this moment has helped to shape my medical career – because it has taught me a valuable lesson about ‘choosing your armour’.

What does martial art training have to do with medicine I hear you ask? It would seem not much aside from ACL tears and heavy concussions, but in fact, I often draw many parallels between my ongoing teaching and training in martial arts and my career in emergency medicine – because they are two arenas that are accustomed to dealing with acutely stressful situations.

So how do we best prepare ourselves for these situations?

Our Physical Armour

The Uniform

Whether it’s a martial arts uniform, a suit or our emergency scrubs, the uniform comes with the territory. Particularly in martial art training, once the uniform is on, your mentality changes. You are no longer the doctor, the sister, the partner or the friend – you are the student, the instructor and the artist. You learn to compartmentalise your life for the hour or two you are training, and instead of worrying about what you’re going to make for dinner or the argument you had with your boss, you let the uniform take over and you focus entirely on the here and now – in its own way, it’s a rather brilliant if not sweat-inducing form of mindfulness.

Our scrubs or work uniform can be the same for us. When we step out of our usual clothes and into our scrubs, we too can adopt the mindful mindset. When getting changed for work, we have an opportunity to acknowledge the character that comes with the scrubs and think, “For the next 10 hours of my shift, I am an emergency physician, and I am going to do the best I can with what I’ve got”. It may seem odd but there is research behind the notion that what we wear can in fact affect how we perform.

The theory of ‘enclothed cognition’ first coined by social psychologist Galinksy (1) arose from a study where participants wearing a white coat identified as a doctor’s coat were found to have greater sustained attention than those who didn’t wear the coat. The theory is based on the concept of embodied cognition, where physical experiences can subconsciously trigger abstract associations (like how carrying a heavy object increases your judgement of its worth) (2). Of a similar vein, Galinsky argues that wearing a particular item of clothing causes people to embody it and adopt its symbolic meaning, thereby influencing the wearer’s own thought processes. For enclothed cognition to work, it relies on an exercise in priming whereby the wearer both physically wears the clothes as well as understands their symbolic meaning, thus priming them to undergo a subconscious change in behaviour (i.e. behave like an emergency doctor should) (2). So by wearing our scrubs and acknowledging the symbolism behind them (i.e. the uniform of a strong, capable, resilient emergency physician), we can actually increase our own performance.

War Paint and Lucky Charms

Before every taekwondo grading, I painted my toenails black to match my belt, and I had a temporary tattoo of the symbol for ‘power’ placed on to the ankle of my dominant kicking leg as a reminder for me that I am strong and capable. Now while working in the emergency department, if I know I’m in for a rough day (hello Monday evening shift!) then I seldom arrive without bright lipstick. For me, it’s like a lucky charm, but I prefer to think of it like my own war-paint, a psychological cue that I am going to succeed in battle today, whatever that may look like. For other people, this ritual may involve applying a spritz of a favourite perfume or cologne, carrying a particular stethoscope, or maybe bothering to wear matching socks or underwear.

While using these tools may seem like superfluous superstition, they can actually be helpful for our performance. In fact, having an allocated lucky charm or using ‘good luck’ phrases like “break a leg!”, are associated with improved dexterity, motor performance and memory (3). The mechanism behind it is that the perceived ‘luck’ associated with the charm actually increases an individual’s belief in their own self-efficacy and ability to complete the task, which therefore improves their performance (3). You’ll never discount wearing your lucky undies again!

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